You can be obese and healthy, but you can also lose weight in a positive way

• The “health at every size” debate was recently reignited by a Cosmopolitan UK feature featuring various body shapes and sizes.
• Research suggests healthy habits lower mortality risk regardless of BMI, but a study found abdominal fat was linked to higher mortality risk.
• For some people, attempting to lose weight damages their mental health, but it’s possible to do so safely.
• Health and weight aren’t perfectly intertwined, and the lack of nuance on social media is unhelpful.
• Visit Insider’s homepage for more stories.

Over the past decade, the body positive movement has grown, encouraging people to love themselves as they are, regardless of whether they fit a body ideal widely perpetuated in western society.

Body positivity (which was created by plus-size Black women and stemmed from the fat activism movement which gained momentum in the 1960s), anti-diet, “health at every size” – there are various growing camps of people loudly championing self-love online.

At the same time, discussing weight loss has become somewhat taboo.

However, obesity is a huge problem globally. In September 2020, the rate of obesity in the US hit a new high of 42%, which is an increase of 26% since 2008.

As links between weight and risk of death from the coronavirus came to light last year, is it time we lifted the weight loss taboo? Insider asked an array of experts in medicine, nutrition, fitness, and self-love to weigh in on the matter.

A Cosmopolitan feature reignited the debate around 'health at every size'

As the body positivity movement has gained traction, it's become a trend that everyone, from influencers to glossy magazines, wants to capitalize on (a recent Vox article deemed this "performative activism.")

Cosmopolitan UK sparked a debate with a feature in its latest issue, titled "This is healthy," including 11 women of different body shapes and sizes.

A post shared by Cosmopolitan UK (@cosmopolitanuk)

British personal trainer James Smith posted a video on Instagram saying that, while he is against the idea that everyone should be shredded, "we shouldn't really be putting 'this is healthy' with an obese person, irrespective of how they feel about it. Because objectively, obesity isn't healthy. As a society, we shouldn't be shaming it, but we shouldn't be glorifying it either."

A post shared by James Smith (@jamessmithpt)

Alex Light, an anti-diet influencer and one of the women in the feature, said: "Health doesn't have a size, that's a diet culture lie. The right size for you is the one where your body is fed and nourished and you're not restricting."

A spokesperson for the magazine told Insider: "Our aim is to make sure that no-one feels excluded from the wellness space and we hope this issue will help inspire our readers, whatever stage of their fitness journey, feel empowered to make their mental and physical health a priority during this time."

'People disguise their fatphobia as health concerns'

Stephanie Yeboah, self-love advocate and author of "Fattily Ever After," told Insider she thinks it's strange when people say features like Cosmo's promote obesity, because "the whole point of the body positivity and fat acceptance movement is to include bigger bodies in the conversation around respect and desirability."

Yeboah believes many fat people are scared to exercise in public because they are often shamed (which is increasingly publicized), and this - the perception of overweight people - is a big issue.

"I think, for the most part, people tend to disguise their fat-phobia as health concerns," Yeboah said. 

This is a sentiment shared by Dr. Natasha Larmie, a British general practitioner who runs a blog about her own weight issues called The Fat Doctor. Larmie is against intentional weight loss. Instead, she encourages people to focus on healthy habits - losing weight without focusing on it.

"In order to have good health - physical, mental, emotional - you have to do certain things," Larmie told Insider. "And one of those is, be careful about what you eat - make sure you have good nutrition and a healthy relationship with food."

However, she accepts that obesity is an issue that needs tackling and encourages healthy behaviors that will, for many people, lead to weight loss.

Can you be obese and healthy? 

Last year, a meta-analysis of 72 studies concluded that abdominal fat was linked to higher mortality risk and obesity was linked to lower health-related quality of life. 

According to Dr. Spencer Nadolsky, an American cardio-metabolic medicine physician specializing in obesity and lipidology, a person is metabolically healthy if they have zero components of "metabolic syndrome."

That means not having any of the following: low HDL cholesterol, elevated triglycerides, elevated waist circumference, elevated blood pressure, and elevated fasting blood glucose levels.

But it's not so straight-forward for people with obesity, he says.

"In general, obesity puts you at a higher health risk," Nadolsky told Insider. "If you take an obese person who's fit and has no metabolic abnormalities, they are still probably at a higher risk than someone who doesn't have obesity and is also fit."

A post shared by Dr. Spencer Nadolsky (@drnadolsky)

Larmie agrees that "obesity is definitely a risk factor for disease" but said it's "not a proven fact that obesity causes illness." 

The cause of obesity is complex, she said - involving lifestyle, genetics, medical conditions, socioeconomic status, education, and poverty. "But those very things that are causing obesity are also causing illness, rather than the obesity itself causing illness."

A study published in October 2020 reinforces Larmie's view, finding that healthy lifestyle habits are linked to a significant decrease in mortality, regardless of BMI (body mass index - generally a flawed concept on an individual level but still useful for assessing large groups).

And in January 2021, a new study reinforced research associating obesity with diabetes, high blood pressure, and high cholesterol, but confirmed that keeping physically active, regardless of BMI, can lower your risk of all these.

Social media has led to an unhelpful lack of nuance 

Personal trainer Luke Worthington believes part of the problem is that a lot of knowledgeable trainers and media outlets are afraid to answer questions about fat loss or even acknowledge it as a valid goal.

"When someone has either identified themselves, or been advised by a healthcare professional, that their weight is a health concern (either too high or too low), it can't be the answer to tell them just to accept it. That can't be all that we do," he told Insider.

Worthington believes that instead of not talking about weight loss at all, we should be educating people on how it can be done safely and healthily. If qualified trainers and media organizations won't talk about healthy weight management, that's when things get dangerous, because people turn to unqualified and less knowledgeable influencers for the answers, he said.

Nadolsky agrees that the dichotomy seen on social media between both ends of the scale doesn't reflect reality for the general population.

How to lose weight in a healthy, positive way

Yeboah works out every morning for her mental health and to improve her strength and flexibility. She has exercised with the aim of losing weight in the past, but said it "triggered bad eating disorder habits."

"Focusing on a number, whether on the scale or your clothing size, leads to being obsessive with eating and exercise and losing the enjoyment," registered dietitian Shana Spence told Insider. 

Some people try to lose weight, but are unsuccessful or regain it, and are psychologically harmed by the experience. Some become unhealthily lean. However, this isn't the case for everyone.

Personal trainer Emily Ricketts regularly posts on Instagram about how losing weight was linked to developing a healthier relationship with food and her body.

A post shared by EM RICKETTS 💪🏻 (@emrickettz)

Similarly, personal trainer and fat loss coach Anjuli Mack told Insider that many of her clients fall in love with how much better they feel once they start making healthier habits, even if the initial aim was weight loss.

"A lot of the women who come to me are looking to increase their confidence," she told Insider. "Most of them start feeling better within the first two weeks and it's nothing to do with the scale, it's down to the foods they're putting into their body and the actions they're taking each day."

Research shows that weight loss can improve various health markers, including risk of diabetes, cardiovascular disease, and cancer, for overweight and obese people.

"Just because a lot of people fail doesn't mean you shouldn't try," Nadolsky said. "There may be individuals whom intentional weight loss will harm. There's the anti-diet crew on one side and the pro-weight loss on the other, but a good clinician knows that things really lie in the middle."

There's no 'one-size-fits-all' approach to health

Ultimately, this is not a black and white issue. As personal trainer Ben Carpenter said in a recent Instagram video, health and weight aren't perfectly intertwined.

A post shared by Ben Carpenter (@bdccarpenter)

"We need to start getting used to the idea of body diversity," Spence said. "Everyone has a predisposed body type which is influenced largely by genetics. Not everyone is going to be thin, can be thin, or even wants to be thin."

Yeboah added: "It's important for people to know that you can be beautiful and attractive and worthy at any size."

However, we can talk about weight loss without reinforcing the message that a person's worth is based on a number on the scale.

You can be obese and healthy, but you can also lose weight and be healthy.

"Self-love is keeping yourself healthy," Worthington said. "It's not being so overweight that it compromises your health, or being so lean that you lose your periods. Not addressing issues at either extreme isn't self-love, it's self-neglect."

Read more:

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